Building a Diagnosis from the Ground Up

Abstract

A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever. On examination, he had a temperature of 38.1°C but appeared well. A urinalysis revealed numerous white cells, two red cells, and more than two bacteria per high-power field. A urinary tract infection was diagnosed, and oral gatifloxacin was prescribed. Possible causes of this patient's illness include a genitourinary process (such as a bladder stone, urinary tract infection, or prostatitis) or an intra-abdominal process (diverticulitis, appendicitis, or a localized abscess), that can result in irritation of the bladder. Although a bacterial urinary tract infection was diagnosed by the patient's clinician, this patient may have a more unusual diagnosis, given that cystitis is uncommon in men younger than 50 years of age. Although gatifloxacin provides adequate antimicrobial coverage for most bacterial urinary tract infections, it is worth noting that this medication is no longer available because of its associations with hyperglycemia and hypoglycemia. The patient returned the following day, reporting an inability to urinate. A urinary catheter was placed; the urine was clear and yellow. A renal ultrasound study revealed normal kidneys without ureteral dilatation. The patient's urinary retention was thought to be due to opioid use for chronic low back pain. The urology service was consulted, and the patient was discharged home with an indwelling urinary catheter and a prescription for oral doxazosin. Treatment with gatifloxacin was continued, and a urology appointment was scheduled for the following week.

Ecologic Niche Modeling of Blastomyces dermatitidis in Wisconsin

“…In contrast, relatively few cases of blastomycosis are reported from counties in southcentral and southwestern Wisconsin. Despite this information, distribution maps for blastomycosis in the U.S. published as recently as 2007 continue to show northcentral Wisconsin as being non-endemic for the infection (Figure 1B) [2], [9].…”

“…Note that northcentral Wisconsin is not included as an endemic area in this map published in 2007. Reprinted with permission from the New England Journal of Medicine [9].…”

A case of disseminated blastomycosis with pulmonary, genitourinary, and osteoarticular involvement in southern Saskatchewan

“…This patient's disseminated disease also involved his foot and prostate. Urinary obstruction secondary to prostatitis is a recognized manifestation of blastomycosis (16). It should be noted that the first two sets of urine culture returned negative.…”